Bulletin. Service Update Activity Type Elderly Waiver and Alternative Care Programs TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE

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1 Bulletin NUMBER # DATE August 9, 2018 OF INTEREST TO Cunty Directrs Scial Services Supervisrs and Staff Cunty Public Health Directrs Tribal Health Directrs Lng Term Care Cnsultatin Cntacts HCBS Prgram Managers Managed Care Organizatins ACTION/DUE DATE Please read infrmatin and prepare fr implementatin effective August 1, EXPIRATION DATE August 9, 2020 Service Update Activity Type Elderly Waiver and Alternative Care Prgrams TOPIC An Activity Type has been created fr use when Lng Term Care Screening Dcument (LTC SD) changes are needed t supprt service changes fr Elderly Waiver r Alternative Care participants prir t annual reassessment. PURPOSE Describe the purpse, implementatin and limitatins f a new Activity Type 10 fr use by case managers/care crdinatrs when infrmatin abut needs must be updated in a LTC SD t supprt service changes. CONTACT Jlene.Khn@state.mn.us r (651) DHSResurceCenter@state.mn.us fr MMIS supprt SIGNED CLAIRE WILSON Assistant Cmmissiner Cmmunity Supprts Administratin TERMINOLOGY NOTICE The terminlgy used t describe peple we serve has changed ver time. The Minnesta Department f Human Services (DHS) supprts the use f "Peple First" language. Minnesta Department f Human Services PO Bx St. Paul, MN

2 Page 2 I. Backgrund Lead agency 1 assessrs determine eligibility fr hme and cmmunity-based (HCBS) prgrams, including the Elderly Waiver (EW), Alternative Care (AC), and Essential Cmmunity Supprts (ECS) fr peple age 65 and lder. The assessr cmpletes a face-t-face assessment t determine service eligibility and develp a Cmmunity Supprt Plan (CSP) fr these prgrams, using MnCHOICES r the LTCC Assessment legacy frm. Annual face-tface reassessments are als required t re-establish service eligibility fr these prgrams. Results f these assessments are dcumented in the Medicaid Management Infrmatin System (MMIS) t establish eligibility perids, and allw prir authrizatin f services. In additin t establishing and recrding eligibility, fr peple in EW, AC r ECS, MMIS als generates mnthly standardized budget amunts 2 t supprt HCBS services, and establishes eligibility fr 24 hur custmized living service rate limits, bth based n infrmatin entered related t the persn s needs. Case managers and/r care crdinatrs are respnsible t develp the crdinated services and supprt plan (CSSP) 3 fr eligible individuals, mnitr the adequacy f the plan, respnd t participant requests fr changes in services and service ptins, and update the CSSP as needed. Over the curse f a service year, a case manager/care crdinatr must be able t amend the CSSP in respnse t changes in need that are unrelated t eligibility, as well as t reflect hw these changes affect participant chices in services and gals. When changes in need and necessary changes t the CSSP require a change in the mnthly case mix budget limit established in MMIS fr EW and AC participants, and/r t establish eligibility fr 24 CL fr EW participants, sme infrmatin abut the persn s needs must als be updated in MMIS. Updating infrmatin abut needs has nly been allwed in the MMIS if a lead agency uses the reassessment Activity Type 06. II. Activity Type 10 Service Change Aging and Adult Services Divisin has develped a new activity type in the Lng Term Care Screening Dcument in MMIS, called a service change. This new activity type will allw EW and AC case managers r EW care crdinatrs ( case managers fr purpses f this bulletin) t make changes needed t update budget and service eligibility infrmatin fr EW/AC participants, in rder t be respnsive t changes that may ccur fr a participant between their regularly scheduled annual reassessments. A. Purpse f AT 10 This activity type was created t allw case managers t respnd t changes in need that require changes in the service plan, and t differentiate a reassessment required t be cmpleted annually by an assessr t redetermine eligibility fr EW and AC frm thse changes needed t update budget and service eligibility 1 Lead agencies include cunties, and tribes and managed care rganizatin that cntract with the department fr the administratin and management f HCBS prgrams. 2 Including budget amunts fr peple wh chse cnsumer-directed cmmunity supprts under EW r AC. 3 Managed care rganizatins als use a Cllabrative Care Plan r CCP. Minnesta Department f Human Services PO Bx St. Paul, MN

3 Page 3 infrmatin. Case managers can use Activity Type 10 when changes t the CSSP require a change in the mnthly case mix budget amunt, r the establishment f eligibility fr the 24CL rate limit in rder t prvide the resurces necessary t supprt the needed service change(s). A cmplete reassessment wuld nt be required. The Lng Term Care Screening Dcument (LTC SDOC) subsystem in MMIS prvides systems supprt t pen individuals t these prgrams, calculate and assign budgets, cntrl the services that are included under prgrams, and s n. The ability t update sme infrmatin related t resurces and services rather than eligibility is needed fr the Elderly Waiver and Alternative Care prgrams because, fr these prgrams, the LTC SDOC als: Establishes the persn s mnthly case mix budget limit fr hme and cmmunity-based services t be included in the crdinated service and supprt plan (CSSP); Verifies eligibility fr the 24 hur custmized living service rate limit; Manages changes related t access t the cnsumer-directed cmmunity supprts (CDCS) service ptin and CDCS budgets; and Captures infrmatin abut fees fr AC participants that is updated when services change. Activity Type 10 wuld nt be necessary when: The change in the service plan is nly a change in prvider(s). Fr example, a persn selects a different transprtatin prvider, r anther transprtatin prvider is added t the CSSP. Needs have changed but the change(s) des nt affect the case mix budget, CL r 24CL rate limit, r CDCS budget. Fr example, a persn may have an increased need fr assistance with laundry and will need additinal hmemaker service. A new service (r mre f a service) is needed r chsen by the persn, but there is funding available within their currently established mnthly case mix budget limit. Fr example, the persn has need fr assistance with hmemaking, has previusly declined, and nw chses hmemaker service. There is funding available within their current custmized living (CL) r 24 hur custmized living (24CL) service rate limit fr additinal cmpnent services needed. Fr example, the persn has an assessed need fr assistance with bathing, but has required mre time than anticipated in the current service plan, and mre units f staff time fr bathing are needed. The CL/24CL plan wuld be updated and a new Residential Services Tl wuld be submitted t change the authrized rate. B. Plicy parameters fr the use f Activity Type 10 A lead agency can always pt t cmplete a full reassessment based n the extent r nature f changes in need that require a change in services. The use f Activity Type 10 is never required, but has been develped t allw an efficient, timely, and effective way t update assessment infrmatin as needed t allw access t additinal resurces fr the EW r AC participant ver the curse f a service year. When AT 10 is used, certain plicy parameters are in effect: This AT is nly available fr EW and AC prgram case managers. The case manager infrmatin n the AT 10 dcument must match the case manager Minnesta Department f Human Services PO Bx St. Paul, MN

4 Page 4 infrmatin n the last apprved LTC SDOC in MMIS. This AT des nt extend the waiver span. This means that any additinal budget resurces resulting frm AT 10 will be prrated thrugh the remainder f the current service year (waiver r AC span). Mre than ne AT 10 can be perfrmed in a given service year (waiver r AC span). This AT des nt replace an annual reassessment. AT 10 can nly be cmpleted based n a case management visit t a persn and cannt be based n infrmatin prvided slely by a prvider. This Activity Type cannt be used t exit a persn frm a prgram, des nt replace reassessment, and cannt be used t change level f care r ther prgram eligibility fields in MMIS. C. DHS Frm 3428G fr use with AT 10 The Aging and Adult Services Divisin created a new frm t supprt the use f Activity Type 10. This frm, DHS 3428G, includes the legacy assessment questins frm DHS Frm 3428, fr thse items related t case mix classificatin, 24CL eligibility, and ther items that may require updating t reflect changes in need and in the CSSP. This frm is nt required t be cmpleted in full. It is t be used t recrd and update nly thse items related t changes in the persn s needs that will require additinal resurces and/r changes t the CSSP. It includes reminders and space fr infrmatin that will be reflected in changes t the CSSP/CCP. Changes in the CSSP may include additinal amunts f current services, r the additin (r discntinuance) f ther services. Changes in need may establish eligibility fr 24 CL rate limits. And changes in service plans fr the AC participant may affect any fees established fr the persn. The frm includes instructins fr case manager cmpletin f relevant items, reminders t update sectins f the CSSP, and reminders t review ther persn-centered planning elements t ensure any changes in these areas f life are als updated as apprpriate. The frm includes ntes abut MMIS data entry and instructin t prvide a cpy f the cmpleted frm t the persn s lead agency when the case manager is nt als the assessr, s any changes can be incrprated int the annual reassessment when cmpleted. The CSSP is updated whenever there are changes in services, prviders, and/r tasks t be cmpleted by current r new prviders, including the effective date f the change(s). A cpy f the updated CCSP must be frwarded t the relevant parties fr signatures as required. This dcumentatin and cmmunicatin requirement is nt limited t changes t the CSSP based n the use f Activity Type 10. D. Use f AT 10 and changes t CL/24CL service delivery plan and rate Activity Type 10 shuld nt be used when there is funding available within a persn s current custmized living (CL) r 24 hur custmized living (24CL) service rate limit fr additinal cmpnent services needed t meet assessed needs. In the example prvided abve, a persn has an assessed need fr assistance with bathing, but Minnesta Department f Human Services PO Bx St. Paul, MN

5 Page 5 has required mre time than anticipated in the current service plan, and mre units f staff time fr bathing are needed. Changing the apprved units f cmpnent services in the CL/24CL service plan t increase resurce required t meet identified need must be based n prvider dcumentatin submitted t the lead agency that demnstrates that, ver a perid f time, additinal services are needed t address identified needs. Revisins that result in a change in the authrized rate require that a new Residential Services Tl be submitted t the department fllwing the usual prtcl. When AT 10 is used fr a persn currently receiving CL r 24CL service, and the CL service plan and rate will be adjusted, AT 10 must be used t update the assessment infrmatin as part f submitting a revised Residential Services Tl t DHS. The effective date f a rate change cannt be prir t the date the Activity Type 10 was cmpleted. A cpy f the Residential Services Tl must als be frwarded t the prvider, and prvider signatures must be btained as required. See Bulletin fr cmplete infrmatin abut cmmunicatin requirements between lead agency assessrs, case managers and CL/24CL prviders. There is n requirement t cmmunicate with the prvider prir t using AT 10 as utlined in Minnesta Statutes, sectin 256B.0915, subdivisin 3a, paragraph (d) regarding assessments. Activity Type 10 des nt represent a reassessment, and it is assumed that prviders and case managers cmmunicate in an nging manner as case managers mnitr the adequacy f the CSSP/CCP in meeting an individual s needs. III. MMIS Infrmatin - Activity Type 10 MMIS has been updated t supprt the use f AT 10 and implements the fllwing rules: This Activity Type is available fr use with an Activity Type Date effective August 1, 2018 r later. It will nly be allwed fr Prgram Types 03, 04 (EW) and 09, 10, and 22 (AC). The case manager infrmatin n the AT 10 dcument must match the case manager infrmatin n the last apprved LTC SDOC in MMIS. Use AT 05 t update the case manager infrmatin if needed befre entering an AT 10 dcument t avid edits. It des nt extend the eligibility span. A full annual reassessment must still be cmpleted. Because it des nt expend the span, any Service Agreement changes in the header dllar amunt resulting frm cmpletin f AT 10 will be prrated fr the remaining mnths f the current span. It can nly be used fr current AC r EW participants. It cannt have an Effective Date prir t the Activity Type Date f AT 10. AT 10 cannt be used t make retractive changes. Updating AC fee infrmatin in MMIS A persn n the AC prgram may need t pay a fee, r their current fees may change, based n the changes t the service plan made using Activity Type 10. AC fees are calculated using varying percentages, and this percentage is then applied t the ttal AC mnthly service plan cst t establish the fee amunt the persn will cntribute. And sme individuals are nt subject t any fee amunt. Minnesta Department f Human Services PO Bx St. Paul, MN

6 Page 6 The amunt f the mnthly fee, r the exclusin frm fees, is determined when cmpleting the AC financial eligibility wrksheet(s), using DHS Frms 2630, 2630A, and Fr thse participants nt required t pay a fee, the exclusin reasn is dcumented n the LTC screening dcument frm DHS-3427 in sectin H and recrded n the MMIS screen ALT6. If an exceptin is nt met, and the persn is subject t a fee, the mnthly fee is recrded n the MMIS service agreement ASA2 screen. This amunt shuld be updated when AC service plans change. Als see Chapter in the manual DHS-4625 fr the fee schedule. Sessin 18 in the nline MMIS training series explains the AC fee fields n the ASA2 screen in the Service Agreement, and hw t update thse amunts t ensure accurate billing f the AC participant, including when AC service csts are reduced. IV. Additinal Resurces All DHS Frms can be fund at Bulletins fr the mst recent three years can be fund at The Lng Term Care Cnsultatin Services (LTCC) manual, Instructins fr Cmpleting and Entering the LTCC Screening Dcument and Service Agreement int MMIS can be fund at r as DHS Fr managed care ppulatins, DHS 4669 and DHS 5020A are the equivalent MMIS manuals fr MSHO and MSC+, and SNBC, respectively. Case mix classificatin infrmatin is fund in DHS Frm 3428B. MMIS nline training series infrmatin can be fund at Americans with Disabilities Act (ADA) Advisry This infrmatin is available in accessible frmats fr peple with disabilities by calling (651) (vice) r tll free at (800) TTY users can call thrugh Minnesta Relay at (800) Fr Speech-t- Speech, call (877) Fr additinal assistance with legal rights and prtectins fr equal access t human services prgrams, cntact the agency s ADA crdinatr. Minnesta Department f Human Services PO Bx St. Paul, MN